Individual
MRS. LORI K BOURNE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.A.
Contact information
Practice address
1395 N COURTENAY PKWY STE 106, MERRITT ISLAND, FL 32953-4474
(321) 452-1224
(321) 453-7784
Mailing address
9960 NW 116TH WAY STE 13, MEDLEY, FL 33178-1175
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA2514
FL
Other
Enumeration date
09/16/2008
Last updated
01/10/2025
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